Platinum Dental Spa PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PLATINUM DENTAL SPA PLLC

Practice address

13660 N 94TH Dr Ste B1
Peoria, AZ 85381-4848

Phone

(623) 977-2551

NPI assigned

Jun 29, 2017

Organization subpart

No

Name

Dr. Andrea J Botar, DDS

Title

Owner

Phone

(623) 977-2551

• Modern Dentistry of SunCity Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1124549191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13660 N 94TH DR STE B1",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814848",
            "telephone_number": "623-977-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13660 N 94TH DR STE B1",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814848",
            "telephone_number": "623-977-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATINUM DENTAL SPA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BOTAR",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-977-2551",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Dentistry of SunCity",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Modern Dentistry of SunCity",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.